Why laughter is not “frivolous”: Keeping burnout at bay in IR

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Matthew Gibson

Matthew Gibson (Royal Berkshire Hospital, Reading, UK) will be delivering this year’s British Society of Interventional Radiology (BSIR; 2–4 November, Glasgow, UK) Wattie Fletcher Lecture ‘Survive and thrive in interventional radiology [IR]’. Interventional News spoke with Gibson to glean some of the details of his talk, in which he will address the “psychological and non-medical stresses and strains of being an interventional radiologist and even suggest some things we can do to improve the situation.”

From Gibson’s preview, it would appear that he intends to underline in the lecture how “just trying to get through to the next day is not enough” as an interventional radiologist. A self-professed enthusiast who, from personal experience, knows the value of enjoyment and laughter at work, Gibson makes a compelling case for thriving over mere survival in IR.

“I have an interest in several areas of IR, for example below-the-knee angioplasty, dialysis access, and deep venous intervention but I am sure there are plenty of people better qualified than me to talk on these topics,” Gibson begins, talking through how he chose his lecture topic. He wanted to make it relevant and interesting to a wide audience. In a career of 25 years as a consultant interventional radiologist, he has “retained his enthusiasm for the job and IR in general”. This has surprised his contemporaries and younger colleagues, who have seen stress and burnout lay claim to many medical professionals’ enjoyment of their job. He felt he was well placed to produce a talk on the all-too-common stresses of IR, rather than a more specific procedure or medical talk about a certain area of IR.

Before delving into burnout and the many contributing factors that make this a reality for many interventional radiologists, Gibson states his keenness to work discussion of serious adverse events (SAEs) into his lecture. Namely, he expresses a desire to examine beyond the important impact of SAEs on the patient’s safety: the effect involvement in a SAE can have on medical professionals. “It is something we do not talk about enough, but SAEs produce a definite adverse effect on medical staff”. This can result in, according to Gibson, damage to confidence and self-esteem and anxiety about making another mistake and, he adds, “you are more likely to be involved in another adverse event if you have already had one.”

“Death by 1,000 arrows” is the metaphor Gibson uses to characterise how the UK healthcare system investigates adverse events. “Although it is supposed to be a no-blame medical culture, being under investigation at any level can be damaging and upsetting. Anyone can refer a doctor to the General Medical Council [GMC], which can be extremely stressful,” Gibson relays, emphasising that doctors have taken their own lives after being referred.

Opening the issue of stress and burnout back up, Gibson again suggests that “[he does] not think we have talked about it enough in IR”, suggesting that this “[may be because] some of us think we are immune to it.” However, “we are all at risk”, he counters, moving on to list multiple explanations for this. Paperwork, emails, directly looking after our own patients”, work-life balance and “time poverty”. In addition, the public’s attitude plays a role, Gibson notes—“the medical profession is less respected than previously and patients and relatives may not understand the subtleties of why mistakes occur and the effect making mistakes, and being the subject of complaints, can have on the medical staff involved.”

In addition, lack of professionalism and rudeness at work “can make your IR team dysfunctional and negatively impact on patient care”.

Yet, there are positive steps that can be taken to mitigate the strain of working in modern medicine and IR, Gibson points out. “Governments, employing organisations, managers, interventional radiologists and their team members can take steps to redress work-life imbalance, time poverty, improve resilience and, hopefully, reduce the risk of burnout and also improve patient safety.”

Interventional radiologists would also stand to gain from understanding that “being vulnerable is not a weakness,” Gibson advises, labelling this as “a real issue for us—we are expected to be invulnerable, to ride into high-stress situations and know what to do with no doubt in our mind.” Be this as it may, “you probably also need to be vulnerable at times in order to have a caring, empathetic relationship with your patients,” Gibson admits, elaborating on the importance of “shedding this armour”. Being invulnerable also “spills over into your private life—doctors can have issues with depersonalisation and desensitisation and thus cut themselves off from their loved ones.”

“Having a laugh with staff and patients might seem frivolous because medicine is a serious business, but it can have some very positive effects,” Gibson offers as part of the explanation for his having staved off burnout 30 years into his IR career.

“I cannot pretend that I have all the answers but stress and burnout are very much with us now and are probably only going to get worse.” This is what he expects the BSIR’s first survey into burnout among interventional radiologists to show and is why “it can be quite difficult to convince junior doctors or medical students how much of a privilege it is to care for patients.” Such, Gibson says, is his “humble opinion”, but he is convincing in how he conveys a need to address the issues that will form the basis for his lecture.


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